Role of a Hospice RN in the SNF?

[brenrn06]

I am a hospice RN of about four months now. I have recently been given my first SNF facility patients. I am having a problem clarifying my role vs the role of the SNF nursing staff. I am receiving phone calls regarding medical problems with these patients that are not comfort care related. The request goes something like this... "YOUR patient is having the following problem ... Can you please call the DR?" My response is "I am with another patient and am not able to leave right now to assess that patient. Since you have already done your assessment and identified the problem can YOU call the DR for YOUR patient?" I usually get the response from the nurse that they are too busy to call the MD. They seem to feel that their only obligation to our mutual patient is to notify the hospice nurse and document it. I thought the role of the hospice nurse was supportive and not primary? Can anyone help me clarify my role? Thanks in advance for your comments.

[MJ Marx]

I have worked in SNF's with Hospice nurses coming in, and now I'm a Hospice nurse who visits the SNF. Check with your supervisor and find out what the "arrangement" is. We had to write out the expectations of each role. And as the Hospice nurse I will make recommendations regarding the Hospice standing orders, then the SNF nurse will ask the primary doc for the order for the recommendation I gave, write and implement said order. Also will then copy that order for the Hospice chart.

[LMTRN]

Your clinical manager needs to speak to the DON about what role you are expected to play.

[catlvr]

We have several different hospice companies coming into our facility. All of them state that the SNF has primary care, and that we are to call the doc for orders when we need them and then get them approved by the hospice. This is a bit of a hassle for us, since it means two calls (and you know how limited time is in LTC!) and sometime there is a struggle between what the doc, the hospice nurse, and the ltc nurse feels is best for the patient. I love having hospice for our patients since they are experts on dying, but for the long term care patients, honestly - the ltc nurse knows that individual best, so please respect their knowledge.

e

[Hospice Nurse LPN, BSN, RN]

We have several different hospice companies coming into our facility. All of them state that the SNF has primary care, and that we are to call the doc for orders when we need them and then get them approved by the hospice. This is a bit of a hassle for us, since it means two calls (and you know how limited time is in LTC!) and sometime there is a struggle between what the doc, the hospice nurse, and the ltc nurse feels is best for the patient. I love having hospice for our patients since they are experts on dying, but for the long term care patients, honestly - the ltc nurse knows that individual best, so please respect their knowledge.

e

That does sound like a lot of double work. In the facility I visit, I'll call and get the orders (if it pertains to the hospice dx), write the order in their charts and make a copy for our chart. For anything non-Hospice related, the facility gets their own orders.

What orders does the hospice have to approve of? Anything related to the hospice dx should come from the hospice med dir.

You are absolutely correct when you stated that the LTC nurse knows the pt best. Y'all know the pts. You were w/ them when they were up and walkinng around. You know the family dynamics (and can clue us in). Hospice is there is compliment the care you give, manage pain and symptoms. It took me about 6 months to get a good working relationship w/ the facility I visit. I know of a couple of hospice nurses w/ other companies who go into the LTC's and treat the nurses like ****. I witnessed this first hand a couple of weeks ago.

Keep up the good work and thank you for taking care of those wonderful "seasoned" adults.

[tewdles, RN]

Hospice nurses are partners with the facility nurses in the care of the patients living there. It is imperative that we have good, professional, trust relationships with that staff so that we can meet their needs along with the needs of the patient and family.

[handyrn]

Does anyone know the CMS regulations that speak to the different roles and responsibilities?